scholarly journals Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1035
Author(s):  
Eva-Maria Winkelmeyer ◽  
Justus Schock ◽  
Lena Marie Wollschläger ◽  
Philipp Schad ◽  
Marc Sebastian Huppertz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Joint Stability ◽  
Anatomic Landmarks ◽  
Human Knee Joint ◽  
Custom Made ◽  
Tibial Translation

While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.

scholarly journals Posterior meniscal ramp lesions: insufficiently known or underestimated?

2019 ◽  
Vol 67 (3) ◽  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Probe Test ◽  
Anterior Cruciate ◽  
Tibial Translation

Meniscal Ramp lesions are frequently associated with Anterior Cruciate Ligament ruptures. It has been reported to play a key role in the anterior tibial translation the knee joint. Ramp lesions are difficult to diagnose in imaging modality and are under-recognized when using standard anterolateral and anteromedial arthroscopic portals even with probe test.

Dynamic Postural Control Two Years Following Anterior Cruciate Ligament Reconstruction in a Female Collegiate Soccer Player

2015 ◽  
Vol 20 (2) ◽  
pp. 24-29 ◽  
Author(s):  
Michael A. Samaan ◽  
Eric K. Greska ◽  
Matthew C. Hoch ◽  
Joshua T. Weinhandl ◽  
Sebastian Y. Bawab ◽  
...  
Keyword(s):  
Knee Joint ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Minimal Detectable Change ◽  
Joint Stability ◽  
Compensatory Mechanisms ◽  
Main Outcome Measure

Context:ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.Objective:To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).Participant:One Division I female athlete.Main Outcome Measure:The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.Results:ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.Conclusion:Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

Effect of ACL Reconstruction Graft Material on Joint Force Loss During Cyclic Fatigue Testing Using a 6-DOF Motion

2010 ◽  
Author(s):  
Daniel V. Boguszewski ◽  
Jason T. Shearn ◽  
Christopher T. Wagner ◽  
David L. Butler
Keyword(s):  
Fatigue Testing ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cyclic Fatigue ◽  
Anterior Tibial Translation ◽  
Graft Material ◽  
Joint Force ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation

As many as 250,000 people suffer anterior cruciate ligament (ACL) injury annually [1]. As the primary ligamentous restraint to anterior tibial translation [2–3], the ACL is surgically reconstructed in an attempt to restore knee stability. However, up to 10–25% of reconstructions still fail [4]. While reconstructions restore antero-posterior kinematics, abnormal kinematics persist in other directions [5], leading to a shift in cartilage contact and poor adaptation to altered load [5]. With or without reconstruction, the likely prognosis after ACL injury is long-term osteoarthritis [6]. Improving this outcome requires assessment of the limitations of ACL graft reconstruction compared to normal ACL forces during simulated activities of daily living (ADLs). Our objective in this study was to evaluate the magnitude and temporal changes in force for the intact versus ACL-reconstructed knee over 2000 cycles of a simulated ADL.

scholarly journals Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

2018 ◽  
Vol 46 (7) ◽  
pp. 1559-1565 ◽  
Author(s):  
Kwadwo A. Owusu-Akyaw ◽  
Sophia Y. Kim ◽  
Charles E. Spritzer ◽  
Amber T. Collins ◽  
Zoë A. Englander ◽  
...  
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Male And Female ◽  
Mri Scans ◽  
Internal Tibial Rotation ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: The incidence of anterior cruciate ligament (ACL) ruptures is 2 to 4 times higher in female athletes as compared with their male counterparts. As a result, a number of recent studies have addressed the hypothesis that female and male patients sustain ACL injuries via different mechanisms. The efficacy of prevention programs may be improved by a better understanding of whether there are differences in the injury mechanism between sexes. Hypothesis/Purpose: To compare knee positions at the time of a noncontact ACL injury between sexes. It was hypothesized that there would be no differences in the position of injury. Study Design: Controlled laboratory study. Methods: Clinical T2-weighted magnetic resonance imaging (MRI) scans from 30 participants (15 male and 15 female) with a noncontact ACL rupture were reviewed retrospectively. MRI scans were obtained within 1 month of injury. Participants had contusions associated with an ACL injury on both the medial and lateral articular surfaces of the femur and tibia. Three-dimensional models of the femur, tibia, and associated bone bruises were created via segmentation on MRI. The femur was positioned relative to the tibia to maximize bone bruise overlap, thereby predicting the bone positions near the time of the injury. Flexion, valgus, internal tibial rotation, and anterior tibial translation were measured in the predicted position of injury. Results: No statistically significant differences between male and female patients were detected in the position of injury with regard to knee flexion ( P = .66), valgus ( P = .87), internal tibial rotation ( P = .26), or anterior tibial translation ( P = .18). Conclusion: These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising. Clinical Relevance: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.

scholarly journals Excessive anterior tibial translation in the contralateral uninjured limb is significantly associated with ramp lesion in anterior cruciate ligament injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kazuki Asai ◽  
Junsuke Nakase ◽  
Rikuto Yoshimizu ◽  
Mitsuhiro Kimura ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Ramp Lesion ◽  
Anterior Tibial ◽  
Male Sex ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose This study aimed to evaluate the excessive anterior tibial translation (ATT) and muscle strength of patients with ramp lesions. We hypothesised that the higher ATT, lower hamstring-to-quadriceps (HQ) ratio, and higher flexion peak torque influenced by semimembranosus would be associated with ramp lesions. Methods One hundred and twenty-one patients who underwent anterior cruciate ligament (ACL) reconstruction were retrospectively evaluated. Clinical evaluation included ATT of the contralateral uninjured limb measured using a KT-1000 arthrometer, the knee flexor and extensor muscle strength of the contralateral uninjured limb at 60°/s and 180°/s of an angular velocity measured using an isokinetic dynamometer, and HQ ratio at 60°/s and 180°/s during the preoperative state. Binary stepwise logistic regression analysis was performed to evaluate the risk factors of ramp lesions. Results Ramp lesions were found in 27 cases of ACL injuries (27/121, 22.3%). Male sex (odds ratio [OR], 2.913; 95% confidence interval [CI], 1.090–7.787; P = 0.033), longer time between injury to surgery (OR, 2.225; 95% CI, 1.074–4.608; P = 0.031), and higher ATT in the contralateral uninjured limb (OR, 1.502; 95% CI, 1.046–2.159; P = 0.028) were indicated as the independent risk factors of the presence of ramp lesion associated with an ACL injury. Conclusions Male sex, longer period from injury to surgery, and higher ATT in the contralateral uninjured limb were significantly associated with ramp lesion. These findings are advantageous for identifying patients with a greater risk of developing a ramp lesion with an ACL injury in the clinical setting. Level of evidence Level IV

Postoperative physical therapy rehabilitation of patients with anterior cruciate ligament injury - A Bibliographic Review

2020 ◽  
pp. 35098-35102
Author(s):  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Complex Structure ◽  
Ligament Injury ◽  
Anterior Tibial Translation ◽  
Acl Injuries ◽  
Anterior Tibial ◽  
Postoperative Physical Therapy ◽  
Anterior Cruciate ◽  
Tibial Translation

The knee joint is considered a complex structure, which provides stability and mobility, which is composed of bone, muscle and ligament structures. ACL rupture causes knee joint instability with excessive internal rotation and anterior tibial translation, especially when reaching the last degrees of extension, causing limitations in activities of daily living. This work aims to show the effectiveness of physiotherapy in the treatment of ACL injuries. The method started from a bibliographic review, through books, personal files, websites of medicine and physiotherapy available on the internet, magazines and scientific articles in the health area, aiming to illustrate and theoretically base the work. Articles were selected for the present study, in Portuguese and English. The bibliographic survey was carried out with references to publications between the years 2000 to 2017. The present study revealed the importance of Physiotherapy in the process of rehabilitation of ACL injuries. It demonstrated that most patients respond satisfactorily, and resistance levels can be noticed in a few cases.

Detailed Cadaveric Simulation of Landing Reveals Timing Sequence of Multi-Planar Knee Kinematics: Implications for ACL Injury

2013 ◽  
Author(s):  
A. M. Kiapour ◽  
C. E. Quatman ◽  
V. K. Goel ◽  
S. C. Wordeman ◽  
T. E. Hewett ◽  
...  
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Acl Injury ◽  
The United States ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Acl Injuries ◽  
Cadaveric Simulation ◽  
Tibial Translation

Over 120,000 anterior cruciate ligament (ACL) injuries occur annually in the United States, mainly affecting the young athletic population. Non-contact injuries are reported to be the predominant mechanism of ACL injury (>70% of ACL injuries), which often occur during landing with high ground reaction forces, muscle forces and segmental inertia. An improved understanding of the mechanisms underlying non-contact ACL injury and inciting events can be used to improve current prevention strategies and decrease the risk of early-onset osteoarthritis. Previous biomechanical and video analysis studies have demonstrated that anterior tibial translation (ATT), knee valgus and internal tibial rotation (ITR) are associated with non-contact ACL injuries [1–3]. While the effects of these factors on ACL injury risk have been extensively studied, there is still controversy and debate about the timing in which these motions occur and reach maximum values during a jump landing task. The current study aimed to investigate interactions between tibio-femoral joint kinematics and ACL strain through a detailed cadaveric simulation of the knee biomechanical response during landing from a jump. For this purpose, instrumented cadaveric limbs were used to simulate bi-pedal landing following a jump utilizing a novel testing apparatus.

Analyses of Isokinetic and Closed Chain Movements for Hamstring Reciprocal Coactivation

2007 ◽  
Vol 16 (4) ◽  
pp. 319-325 ◽  
Author(s):  
John P. Miller ◽  
Ronald V. Croce
Keyword(s):  
Outcome Measures ◽  
High Speed ◽  
Cruciate Ligament ◽  
Knee Extension ◽  
Anterior Tibial Translation ◽  
Joint Stability ◽  
Closed Chain ◽  
Anterior Cruciate ◽  
The One ◽  
Tibial Translation

Context:Researchers have postulated that coactivation of the hamstrings during active knee extension assists the anterior cruciate ligament in maintaining knee joint stability by exerting an opposing force to anterior tibial translation.Objective:To compare the reciprocal coactivation of the hamstrings while performing low and high velocity isokinetic movements and two closed chain movements.Design:Within subject’s comparison of isokinetic and closed chain exercises.Setting:Biomechanics laboratory utilizing a Cybex norm isokinetic dynamometer and Biopac Data Collection system.Participants:12 healthy women.Main Outcome Measures:The root mean square of the Electromyogram (rmsEMG) was used as a measure of overall muscle activity.Results:The rmsEMG for hamstring coactivation during knee extension showed significant differences between the isokinetic movements and the closed chain exercises with greater coactivation when performing the isokinetic movements. In addition, greater activity was seen at the higher isokinetic velocity and during the one legged squat.Conclusions:These results suggest isokinetic movements, particularly at high speed, can more effectively increase the coactivation activity of the hamstrings when compared to two closed chain activities.

scholarly journals Risk Factors for Anterior Cruciate Ligament Injury: literature Review: مخاطر الإصابة بالرباط الصليبي الأمامي: مراجعة أدبية

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Suleiman Ali Mansi
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Joint Stability ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Anterior Cruciate

  The Anterior cruciate ligament (ACL) plays an important role in maintaining knee-joint stability. Most ACL injures (approximately 65%) are due to a non-contact mechanism during physical activities, particularly in sports involving a landing from a jump, pivoting on the leg, rapid deceleration and cutting maneuvers. The average injury of ACL rates is still high for both professional and recreational athletes in particular between the group ages of 15 to 25 year old. The purpose of this article was to review and analysis the causes and potential risk factors for the ACL injury. Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury, such as shoe-surface interaction, quadriceps angle, knee-joint laxity, genu varum of knee, and body composition. These risk factors most likely act in combination to influence the risk of ACL injury. Therefore, these factors should be considered when designing training programs, competitions, and implementing ACL injury prevention programs.

scholarly journals Restoration of Knee Joint Stability with Cruciate Ligament Implants

2004 ◽  
Vol 11 (1) ◽  
pp. 40-44
Author(s):  
M A Malygina ◽  
N S Gavryushenko ◽  
V P Okhotskiy ◽  
O P Filippov ◽  
A M Nevzorov ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Scientific Research Institute ◽  
Ligament Injury ◽  
Joint Stability ◽  
Human Knee ◽  
Results Of Treatment ◽  
Human Knee Joint ◽  
Different Types

At the Scientific Research Institute of Emergency Care named after N.V. Sklifosovskiy the modern cruciate ligament implants (France) have been successfully used since 1994. Physical mechanical and deformed characteristics of ligaments of human knee joint and synthetic prostheses of ligaments were tested by machine «Zwick-1464». New original endoprostheses of knee joint ligaments as well as instruments for optimization of the points of entrance and exit within condyles were elaborated. The methods for elimination of different types of knee joint instability in cruciate ligament injury using authors' endoprostheses were worked out. Authors proved that it could improve the functional results of treatment.

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